慢性乙型肝炎患者服用核苷(酸)类药物的依从性调查及其影响因素分析

肝脏 ›› 2020, Vol. 25 ›› Issue (11): 1148-1152.

慢性乙型肝炎患者服用核苷(酸)类药物的依从性调查及其影响因素分析

韩宗儒, 闵晓春, 沈启刚, 尹有宽, 王森

201800 上海健康医学院附属嘉定区中心医院感染科(韩宗儒,闵晓春,沈启刚);复旦大学附属华山医院感染科(尹有宽,王森)

收稿日期:2020-05-28 出版日期:2020-11-30 发布日期:2020-12-22
通讯作者: 王森,Email:wangsen329@126.com
基金资助:
十三五重大传染病防治科技重大专项(2017ZX10302201)

An investigation of the adherence to nucleos(t)ide analogue treatment in patients with chronic hepatitis B and analysis of affecting factors

HAN Zong-ru¹, MIN Xiao-chun¹, SHEN Qi-gang¹, YIN You-kuan², WANG Sen²

1. Department of Infectious Diseases,Jiading Central Hospital,Shanghai University of Medicine & Health Sciences,Shanghai 201800,China;
2. Department of Infectious Diseases,Huashan Hospital,Fudan University,Shanghai 200040,China

Received:2020-05-28 Online:2020-11-30 Published:2020-12-22
Contact: WANG Sen,Email:wangsen329@126.com

摘要/Abstract

摘要： 目的评估慢性乙型肝炎(慢乙肝)患者服用核苷(酸)类药物(NA)的依从性及其影响因素。方法入组113例接受NA抗病毒治疗的慢乙肝患者。对其依从性和相关危险因素进行了调查。利用Logistic回归分析评估不同高危因素对服药依从性的影响。结果 113例患者中,有35例(31.0%)报告在过去3个月中漏服大于一剂药物。多因素Logistic回归分析表明,年龄<30岁(P=0.034)、自费药物患者(P=0.031)、合并2种或以上慢性疾病(P=0.021),以及不坚持在同一门诊定期随访的患者(P=0.012)更有可能具有较差的依从性。治疗1年,依从性差的患者HBV DNA的转阴率低于依从性好的患者(51.4% 比79.4%, P=0.004),而病毒学突破发生率高于依从性好的患者(14.3%比2.6%,P=0.017)。结论年龄<30岁、自费药物、合并其他慢性疾病,以及不坚持在同一门诊定期随访与慢乙肝患者服药依从性差相关。

关键词: 慢性乙型肝炎, 核苷类似物, 抗病毒治疗, 依从性, 危险因素

Abstract: Objective To evaluate the adherence of patients with chronic hepatitis B (CHB) to nucleos(t)ide analogues (NAs) and relative affecting factors.Methods This study is a cross-sectional study which collected clinical data of CHB patients taking NAs and investigated their compliance.Logistic regression analysis was used to evaluate the effect of different factors on medication adherence.Results 113 CHB patients were enrolled in this study.35 (31.0%) patients reported that they missed more than one dose in the past three months.Multivariate logistic regression analysis showed that patients younger than 30 years old (P=0.034),self-paid drugs (P=0.031),combined with 2 or more chronic diseases (P=0.021),and patients who did not insist on regular follow-up in the same clinic is more likely to have poor adherence (P=0.012).For patients with poor adherence,the one-year HBV DNA conversion rate was significantly lower than patients with good adherence (51.4% vs.79.4%,P=0.004),and the incidence of virological breakthrough was significantly higher than that with good adherence (14.3% vs.2.6%,P=0.017).Conclusion Our study found that certain factors such as age less than 30 years old,self-financed drugs,combined with other chronic diseases,and failure to adhere to regular follow-up in the same clinic were associated with poor medication adherence in CHB patients.We also confirmed that the poor adherence is directly related to the antiviral therapy effect of HBV infection.These findings can help medical staff to intervene and guide patients to improve the overall adherence of antiviral therapy,and ultimately improve the therapeutic effect.

Key words: Chronic hepatitis B, Nucleos(t)ide analogue, Antiviral therapy, Adherence, Affecting factor

韩宗儒, 闵晓春, 沈启刚, 尹有宽, 王森. 慢性乙型肝炎患者服用核苷(酸)类药物的依从性调查及其影响因素分析[J]. 肝脏, 2020, 25(11): 1148-1152.

HAN Zong-ru, MIN Xiao-chun, SHEN Qi-gang, YIN You-kuan, WANG Sen. An investigation of the adherence to nucleos(t)ide analogue treatment in patients with chronic hepatitis B and analysis of affecting factors[J]. Chinese Hepatolgy, 2020, 25(11): 1148-1152.

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